Hearing is a central part of life. Understanding others, holding conversations, perceiving the environment – all of this is made more difficult when the sense of hearing no longer functions properly. However, a well-fitted hearing aid can restore hearing almost completely. It helps people to continue to participate fully in life. When a hearing aid is useful, whether a hearing aid is paid by the health insurance and what you should look for when choosing your device, we explain here.
How does hearing work?
Hearing involves the three parts of the ear as well as the eardrum, the auditory nerve and the brain. The outer ear receives sound waves with the pinna. They are transmitted to the eardrum via the auditory canal. The eardrum begins to vibrate. The vibration sets the auditory ossicles in the middle ear in motion. They transmit and amplify the sound and pass it on to the inner ear via the so-called round window. In the inner ear, the fluid in the so-called cochlea is set in motion. The cochlea also contains the organ of Corti with hair cells that serve as sensors. The vibration of the fluid causes these hair cells to shear. These shearing movements are converted into electrical impulses that are perceived by the auditory nerve and transmitted to the brain. The impression of hearing is created. Hearing is thus a complex process and requires the interaction of a wide variety of components.
How does hearing loss occur?
Hearing loss occurs when one of the components involved in the hearing process becomes damaged. There are a wide variety of causes for such damage, for example:
- Degenerative (degrading) processes in old age.
- Acoustic trauma (for example, after a loud bang)
- Infections (for example, mumps, Lyme disease).
- Hereditary factors
The most common is sensorineural hearing loss, also called sensorineural hearing loss. Here, the hair cells in the organ of Corti are impaired in their function due to wear. This wear is promoted, for example, by noise, drugs or inflammation.
How do you recognize hearing loss?
Sensorineural hearing loss develops very slowly, so that the symptoms are often only noticed very late by those affected. Hearing loss becomes noticeable, for example, through poor understanding of the other person or an increase in the volume of the television or radio. If the other person is poorly understood, this is often excused with “mumbling” or too loud background noise. It is therefore often the relatives who first notice a deterioration in the hearing performance of their counterpart and who should draw the attention of the person affected to this with the necessary sensitivity. If a hearing loss has been detected, a hearing aid is a good solution and helps to avoid misunderstandings in the partnership or in professional life that may arise due to the hearing loss. It can also help to reduce health problems associated with the constant strain of hearing, such as fatigue, listlessness or headaches. Hearing aids benefit hearing loss that occurs in the ear, but not if the auditory nerve or the part of the brain responsible for hearing is damaged.
For hearing problems: Hearing test
If you have problems in everyday life understanding other people, perceiving sounds or, for example, listening to the television and feel limited as a result, it is useful to have your hearing tested by an ear, nose and throat (ENT) doctor. He or she will use various hearing tests to determine whether a hearing aid is necessary. The tests are used to measure the hearing loss and thus the degree of hearing loss. Among other things, the doctor determines the patient’s hearing curve, i.e. the volume above which a sound can be perceived; for each ear individually and for different pitches (frequencies). Speech comprehension is also checked. Both tests are performed with the aid of headphones and the results are compared with those of people with normal hearing. These normal values are used to determine at what level of hearing loss a hearing aid is appropriate. Alternatively, a hearing care professional can perform a free hearing test. However, for the health insurance company to cover the cost of a hearing aid, a doctor must issue a corresponding hearing aid prescription.
At what point do you need a hearing aid?
An indication for a hearing aid exists when:
- On the better ear the hearing threshold is at least 30 decibels (dB) below that of normal-hearing people
- At a speech volume of 65 decibels (dB) 20 percent of the test words are no longer recognized
In exceptional cases, a hearing aid may be prescribed even in cases of mild hearing loss, i.e. below the indication limits listed above. This applies in particular if the affected person is limited by his hearing loss in his job. In addition, early prescription of a hearing aid can be useful even in cases of mild hearing loss if no improvement in the hearing loss is expected. If one waits too long, a habituation effect occurs and the hearing ability continues to deteriorate unnoticed. The brain then has to learn to interpret these sounds again by wearing a hearing aid. In addition, hearing loss can affect the quality of life: Misunderstandings, a withdrawal from social life and depressive moods can be the result. A hearing aid can easily prevent this.
What happens after a hearing aid is prescribed?
To choose a hearing aid and have it fitted, you go to a hearing care professional with the prescription from your ear, nose and throat doctor. Although all hearing acousticians must offer hearing aids within the price range of the cash benefit (so-called cash models), a price comparison between different acousticians is advisable to find the best possible device. The acoustician makes an impression of the ear canal in order to be able to individually manufacture an ear mould (otoplasty) – i.e. the part of the hearing aid that sits in the ear. Together with the acoustician, the affected person chooses a hearing aid model that fits his or her needs. The technical necessities and wearing comfort should play a primary role here. In addition to the acoustic aspects, cosmetic aspects are also decisive for many wearers of hearing aids (for example, in-the-ear or behind-the-ear devices). The acoustician then performs the technical fine-tuning of the device. He adjusts the amplification to the hearing sensation of the person concerned and to the data collected in the hearing tests. He also gives tips on how to listen properly with the hearing aid, for example when using the telephone or in noisy surroundings, and on proper care, such as cleaning and battery replacement. Once the patient is satisfied with the setting, he or she makes a final check-up appointment with an ear, nose and throat specialist. This checks whether the hearing aid fits well and the hearing loss can be compensated accordingly.
Who helps if problems arise?
If problems such as inflammation, pain when wearing or similar occur in the further course, advice should again be sought from a doctor. For technical questions and adjustments during follow-up care, the hearing care professional is available. Otherwise, nothing stands in the way of wearing the hearing aid every day.
What does the health insurance pay?
If a hearing aid is deemed medically necessary by a doctor, every statutory health insurance company is obliged to cover costs up to a fixed amount of 733.59 euros or 786.86 euros in the case of hearing loss bordering on deafness. In addition to the hearing aid itself, the health insurance benefit includes all medical tests as well as the production and fitting of the hearing aid. Kassengeräte must have the following equipment:
- Digital technology
- 4 or more channels (for different sound frequencies, adaptable to the hearing loss in the respective frequency range).
- 3 or more hearing programs (for example, for restaurant visits or television).
- Feedback and noise suppression
- Setting can be adjusted automatically
- Amplification power above 75 decibels (for hearing loss bordering on deafness).
In many cases, the cash devices are sufficient. However, if a more expensive device is medically necessary, you should ask your health insurance whether the additional costs are covered. If medically necessary, health insurance companies must also cover the cost of more technically advanced equipment. If the wearer opts for a higher-quality device for non-medical reasons, he or she must pay for the costs that exceed the health insurer’s subsidy (co-payment). The health insurance company only covers the cost of batteries up to the age of 18.
What types of hearing loss are there?
Hearing loss can have its origin in different “switching points” of hearing.If the hearing loss affects the outer or middle ear, it is called a conductive hearing loss. If the damage is in the inner ear, it is a sensorineural hearing loss. In both cases, a hearing aid can compensate for the hearing loss.
Central hearing loss refers to damage to the auditory nerve or the brain. Hearing aids or cochlear implants do not help here. The hearing loss that occurs in old age (presbycusis) is caused by degenerative (degrading) processes in the inner ear – especially in the organ of Corti. These are caused, among other things, by the lifelong continuous strain on the hearing. Temporary conductive hearing loss can also occur in the course of a cold, middle ear infection, high earwax production or similar. In this case, a hearing aid is not necessary, but in the case of prolonged complaints, the ear, nose and throat specialist should still be consulted.
Hearing loss – sudden hearing loss
Hearing loss is understood as the very sudden onset of sensorineural hearing loss. Usually only one side is affected. Accompanying tinnitus may occur. Often, no cause for the hearing loss can be determined. It is suspected that a circulatory disorder of the inner ear is responsible. Early drug therapy is important to increase the chances of recovery. However, even with rapid initiation of therapy, there is a great tendency for relapse. Wearing a hearing aid is recommended for permanent hearing loss.
Tinnitus – disturbing noises in the ears.
Ringing in the ears is the German term for tinnitus. They are not an independent disease, but a symptom. A distinction is made between rare, objective ear noises, which are caused, for example, by blood flow in the ear, and more frequent, subjective ear noises, which are caused by information incorrectly formed by the hearing organ. The therapy of tinnitus aims at improving the quality of life, since a cure is usually not possible. Medical and psychological counseling or care help the affected person to develop coping strategies and to no longer perceive the tinnitus as central and threatening. It is also recommended to wear a hearing aid if the tinnitus is often accompanied by hearing loss. This can additionally be used as a “tinnitus noiser”. In this case, it plays a continuous noise that partially masks the tinnitus. If it is to be completely masked, a “tinnitus masker” is used.
What is a cochlear implant?
The cochlear implant is an electronic hearing prosthesis. It can replace inner ear function. It is important that the auditory nerve and pathway are functional. The cochlear implant is positioned behind the pinna under the skin. This requires an operation in which a small incision is made behind the ear. The implant is fixed there in the bone. Through a thin channel, an electrode is inserted into the cochlea, which is connected to the implant. The implant converts the sound waves into electrical impulses. These are transmitted directly to the auditory nerve. Implants are used in cases of total deafness or hearing loss that cannot be adequately corrected by a hearing aid. If a person has lost his or her hearing only after learning speech, an implantation should take place as soon as possible, ideally within six months. This way, stored hearing impressions can be drawn upon. Hearing with the cochlear implant can thus be learned without special hearing training. The costs for a cochlear implant as well as for follow-up therapies are covered by statutory health insurance if medically indicated.
When does a child need a hearing aid?
Hearing is very important for learning speech. Hearing-impaired and deaf children are correspondingly at risk of falling behind in language development. Therefore, hearing problems in children should be detected as early as possible. For this purpose, there is newborn screening and hearing tests as part of the U examinations. If your child shows conspicuous hearing or speech behavior, you should also consult a doctor outside of the U-examinations and despite an inconspicuous newborn screening. Although infantile hearing loss can be congenital, it can also develop after birth due to infections or inflammations, for example. With an early start of therapy, normal speech development can usually be ensured. Hearing aids can be provided from the third month of life.Cochlear implants can be inserted as early as six months of age. Special hearing, speech and language exercises are offered to further support the child’s development. In most cases, attendance at a regular school is possible for children who receive hearing aids in time. The cost of hearing aids for children is covered by health insurance to the same extent as for adults. Until the age of 18, the cost of batteries for a hearing aid is also covered.
